Case Conference September 5th 2012

05-Sep-2012, Divisi Ginekologi Onkologi RSCM

Cervical Cancer IIIB  Progresive, Post Chemoradiation (taxotere 3 series and  complete radiation at 23/8/12)

Bilateral Supraclavicula Lymph Nodes Metastase

Bilateral Hydronephrosis on dj-stent

 

Identity

Mrs.NM, 31yo, 369 48 80,ASKES

 

 

0kt 2011

 

Patiet was in fifth weeks gestational age on second pregnancy and complained about her vaginal bleeding. Antenatal care with obgyn in Singaraja Hospital, was diagnosed low placental previa.

On her sixth week gestational age , patient was stil complaning of her vaginal bleeding, with other obgyn  in Kasih Ibu Hospital, Bali, was diagnosed with polip.

 

Januari 7 ^th  2012

c-section due to leakage amniotic fluid at 33-34 weeks gestational age. After surgery patient still complained of her vaginal bleeding.

 

Peb 2012

Performed byopsi of the cervix, the result was cervical carcinoma

Came to medistra hospital ( Dr.dr.Laila,obgyn(C))and diagnosed  with cervical carcinoma stage IIB and was refered to RSCM, but  not directly performed radiation

Normal defecation and mixturition

 

Menarche 12 yo,P2 ( I.spontan, male, 3500 gram, spontan. II sc due to leakage amniotic, death, sepsis.

Contraseption (-)

Husband : GP, patients is midwife

 

4/6/12

Patient came to policlinic RSCM

Gen state : wnl, no palpable lymph node (inguinal,axila and supraclav)

Gyn state :

Io: exohytic mass in cervix area, fragile , easy bleeding

VRT :exophytic mass , easy bleeding, fragile, process until 1/3 qnterior vaginal wall, firm parametria

 

Supportive data :

Biopsy result  (8/3/12): scuamosa cervical carcinoma,well differentiated

BNO-IVP (15/6/12) :  non visualized left kidney, hydronephrosis grade III and hydroureter up to distal part.

Thorax : normal, no metastase

Rectoscoy : no metastase

Sistoscopy : cystitis polyploid

 

Assessment :

Cervical carcinoma IIIB,bilateral hydronephrosis

Planning : chemo and radiation

 

 

30/6/12 - 12/7/12

 

hospitalized in the ward with anemia

insertion dj stent

 

discussion with dr laila , with low CCT results :( 4/7 : 27,  6/7 : 12; 12/7 : 51),à plan to get taxotere weekly

 

12/7/12, 24/7/12 and 31/7/12

Got chemotherapy-doxotaxel 60 mg , 3 series

 

Complete external and internal radiation ( end at 23/8/12)

 

August 24 ^th 2012

Had lumps in supraclavicula lymphnodes  bilateral with FNAB :positive metastase SCC could be from cervix

Gen state : enlargement of bilateral supraclavicula,left 3x2 cm, right 2x1 cm

Gyn state : necrotic tissue at stump of vagina. Diameter 3 cm

RVT : vagina, portio and parametria were still firm

 

Assessment :

Cervical cancer IIIB  progresive, post chemoradiation (taxotere 3 series and  complete radiation at 23/8/12)

Bilateral hydronephrosis on dj-stent

Bilateral supraclavicula lymph nodes metastase

 

Discussion with Dr.dr.Laila obgyn (C): phaliative phase, discussion in CC

 

 

RE

 

12/7/12

 

24/7/1230/6/130

doxotaxel

 

31/7/12

doctitaxel 60 mg

 

taxotere

 

 

7/8/12

patient with ca cx IIIB

RE 25 x

Toxotere chemo 3 times ( canceled 2 times because the patient condition)

Gen state :

Metastasis of right lymphnode KGB inguinal

Gyn state :

In: v/u normal

Io: necrotic tissue in vaginal stump, diameter 3 cm

RVT : parametrium still not loose, vagina and portioo were firm

 

 

24/8/12

patient contr9oled after IR 3 times

gen state : enlargement of lymphnode at I right nguinal  and left supraclavicula, sternocleiodo

 

27/8

FNAB :

Positif, metastase scc could be from cervix